NUR 211 BURNS – BURTRAM
QUESTIONS AND CORRECT
ANSWERS
What happens to the skin as we age? ANSW✅✅-Flattened dermal-epidermal junction
-Dermal and subcutaneous atrophy
-Reduced microcirculation
-*thinned skin, predisposition to deeper burns, and delayed or poor healing*
-decreased ability to tolerate burn stress *(underlying dz process can complicate)*
What are the mechanisms of burns? ANSW✅✅-Thermal
-Chemical
-Electrical
-Radiation (sunburns, nuclear incident, cancer tx)
-Inhalation injury occurs about 20-50% of the time with skin injury
What is the most recorded mechanism of burn injury in the US? ANSW✅✅thermal (about 90%)
What is thermal injury? ANSW✅✅-Skin damaged by contact with heat
>Flame
>Scalding liquids
>Heat source like a heater
>Steam injuries
What determines the severity of thermal burns? ANSW✅✅-Duration of contact
-Temperature of agent
•↑Risk of injury temperature > 40° C (104° F)
-Amount of tissue exposed
-Age of patient
,What happens to the liquid in our bodies with a thermal burn if the temperature is high enough?
ANSW✅✅Anything liquid in our body turns into a solid (coagulates)
What is the average temperature of a water heater? ANSW✅✅140° F
(120° F - recommended setting)
What are examples of thermal injury? ANSW✅✅flame (e.g., house fires, ignition of clothing,
explosion of gases), scalding liquids (e.g., water, cooking oil, grease), steam (e.g., car radiators,
cooking pots, industrial equipment), or direct contact with a heat source (e.g., space heater, metal).
What factors increase morbidity in burn patients? ANSW✅✅-Burns covering more than 50% of
body surface area
-Inhalation injuries
-Very young and elderly patients
-Additional injuries
What layer of skin do you need to have for your skin to regenerate? ANSW✅✅Dermis (at least
some of it)
What is the function of the skin? ANSW✅✅-Protection from infection
-Prevention of loss of body fluids
-Thermoregulation
-Production of vitamin D
-Excretion
-Determination of identity
-Sensation reception
Why are the young and elderly at increased risk? ANSW✅✅Thin skin, loss of sensation (like from
DM), etc.
How can chemical burns take place? ANSW✅✅-Contact
-Inhalation of fumes
-Ingestion or injection
,What is dangerous about chemical burns? ANSW✅✅-*Systemic* and local effects
-*Must be completely removed or neutralized or damage continues*
How do we treat chemical burns on site? ANSW✅✅-Recommended to rinse it off despite the
agent (alkali vs acid)
-Do not touch the chemical on the other person
-Brush off a powder with gloved hands, never rub. Can use a washcloth to brush off. Remove
clothing. Flush skin with saline or water. 15 minutes if on skin. 30 min if in the eye. Cover with dry
sterile dressing until other orders. The longer the chemical on the skin, the worse the burn. If show
up to the ED covered in the chemical, they have to be decontaminated outside before they can enter
to prevent injuries to others via inhalation.
What determines the severity of chemical burns? ANSW✅✅-Type of agent
-Volume of agent
-Duration of contact
-Concentration of agent
What are the types of chemicals that can cause injury? ANSW✅✅-Alkalies (lye, lime, wet cement,
ammonia)
-Acids (house cleaners)
-Organic compounds (gas, diesel fuel)
What type of chemical causes the most damage? ANSW✅✅Alkalies are the worst. Cause *severe
edema and fluid loss.* *Liquefy the tissue causing liquefaction necrosis.*
What would you assess in a meth lab related burn? ANSW✅✅-Thermal and chemical burn injury
pattern
-A vague or inconsistent injury history
-Burns to the face and hands
-Signs of agitation or substance withdrawal
-Patient is more likely to be a substance abuser...screen for withdrawal to give proper tx
, High vs low voltage burns? ANSW✅✅-High > 1000 volts
-Low < 1000 volts
-High voltage at risk for greater injury
AC vs DC electrical burns? Which is worse? ANSW✅✅-Alternating current vs direct current
-*Alternating current more likely to cause cardiac dysrhythmias like vfib and higher probability of
producing cardiac arrest*
-AC is seen in the power grid (so everything electric in the homes is AC and the power lines)
-Direct current is like batteries
What factors need to be considered with electrical burns? ANSW✅✅-Type and path of current
(Entry and exit wounds - could blow off a limb...very powerful)
-Duration of contact
-Environmental (Lightning strikes)
-Tissue resistance *(Skin, bone, and fat have high resistance while organs, vessels, and nerves have
low resistance to electricity)*
What is particularly dangerous about electrical burn injuries? ANSW✅✅Cannot tell how severe
the burn might be with an electrical burn
What are our 3 major concerns with an electrical burn? ANSW✅✅-Heart
>Need EKG
-Rhabdomyolysis
>s/s include dark red brown (portwine) urine, check CKMB (tissue breakdown), myoglobin levels,
monitor the kidneys (BUN, creatinine, etc)
>*The tissue along the path gets broken down and releases myoglobin into our system, causing
rhabdomyolysis*
>need 75-100 ml/hr of urine
-C spine
>*Tetanic contractions...need C spine precautions until cleared bc the muscles could seize up so bad
it causes c spine fractures*
QUESTIONS AND CORRECT
ANSWERS
What happens to the skin as we age? ANSW✅✅-Flattened dermal-epidermal junction
-Dermal and subcutaneous atrophy
-Reduced microcirculation
-*thinned skin, predisposition to deeper burns, and delayed or poor healing*
-decreased ability to tolerate burn stress *(underlying dz process can complicate)*
What are the mechanisms of burns? ANSW✅✅-Thermal
-Chemical
-Electrical
-Radiation (sunburns, nuclear incident, cancer tx)
-Inhalation injury occurs about 20-50% of the time with skin injury
What is the most recorded mechanism of burn injury in the US? ANSW✅✅thermal (about 90%)
What is thermal injury? ANSW✅✅-Skin damaged by contact with heat
>Flame
>Scalding liquids
>Heat source like a heater
>Steam injuries
What determines the severity of thermal burns? ANSW✅✅-Duration of contact
-Temperature of agent
•↑Risk of injury temperature > 40° C (104° F)
-Amount of tissue exposed
-Age of patient
,What happens to the liquid in our bodies with a thermal burn if the temperature is high enough?
ANSW✅✅Anything liquid in our body turns into a solid (coagulates)
What is the average temperature of a water heater? ANSW✅✅140° F
(120° F - recommended setting)
What are examples of thermal injury? ANSW✅✅flame (e.g., house fires, ignition of clothing,
explosion of gases), scalding liquids (e.g., water, cooking oil, grease), steam (e.g., car radiators,
cooking pots, industrial equipment), or direct contact with a heat source (e.g., space heater, metal).
What factors increase morbidity in burn patients? ANSW✅✅-Burns covering more than 50% of
body surface area
-Inhalation injuries
-Very young and elderly patients
-Additional injuries
What layer of skin do you need to have for your skin to regenerate? ANSW✅✅Dermis (at least
some of it)
What is the function of the skin? ANSW✅✅-Protection from infection
-Prevention of loss of body fluids
-Thermoregulation
-Production of vitamin D
-Excretion
-Determination of identity
-Sensation reception
Why are the young and elderly at increased risk? ANSW✅✅Thin skin, loss of sensation (like from
DM), etc.
How can chemical burns take place? ANSW✅✅-Contact
-Inhalation of fumes
-Ingestion or injection
,What is dangerous about chemical burns? ANSW✅✅-*Systemic* and local effects
-*Must be completely removed or neutralized or damage continues*
How do we treat chemical burns on site? ANSW✅✅-Recommended to rinse it off despite the
agent (alkali vs acid)
-Do not touch the chemical on the other person
-Brush off a powder with gloved hands, never rub. Can use a washcloth to brush off. Remove
clothing. Flush skin with saline or water. 15 minutes if on skin. 30 min if in the eye. Cover with dry
sterile dressing until other orders. The longer the chemical on the skin, the worse the burn. If show
up to the ED covered in the chemical, they have to be decontaminated outside before they can enter
to prevent injuries to others via inhalation.
What determines the severity of chemical burns? ANSW✅✅-Type of agent
-Volume of agent
-Duration of contact
-Concentration of agent
What are the types of chemicals that can cause injury? ANSW✅✅-Alkalies (lye, lime, wet cement,
ammonia)
-Acids (house cleaners)
-Organic compounds (gas, diesel fuel)
What type of chemical causes the most damage? ANSW✅✅Alkalies are the worst. Cause *severe
edema and fluid loss.* *Liquefy the tissue causing liquefaction necrosis.*
What would you assess in a meth lab related burn? ANSW✅✅-Thermal and chemical burn injury
pattern
-A vague or inconsistent injury history
-Burns to the face and hands
-Signs of agitation or substance withdrawal
-Patient is more likely to be a substance abuser...screen for withdrawal to give proper tx
, High vs low voltage burns? ANSW✅✅-High > 1000 volts
-Low < 1000 volts
-High voltage at risk for greater injury
AC vs DC electrical burns? Which is worse? ANSW✅✅-Alternating current vs direct current
-*Alternating current more likely to cause cardiac dysrhythmias like vfib and higher probability of
producing cardiac arrest*
-AC is seen in the power grid (so everything electric in the homes is AC and the power lines)
-Direct current is like batteries
What factors need to be considered with electrical burns? ANSW✅✅-Type and path of current
(Entry and exit wounds - could blow off a limb...very powerful)
-Duration of contact
-Environmental (Lightning strikes)
-Tissue resistance *(Skin, bone, and fat have high resistance while organs, vessels, and nerves have
low resistance to electricity)*
What is particularly dangerous about electrical burn injuries? ANSW✅✅Cannot tell how severe
the burn might be with an electrical burn
What are our 3 major concerns with an electrical burn? ANSW✅✅-Heart
>Need EKG
-Rhabdomyolysis
>s/s include dark red brown (portwine) urine, check CKMB (tissue breakdown), myoglobin levels,
monitor the kidneys (BUN, creatinine, etc)
>*The tissue along the path gets broken down and releases myoglobin into our system, causing
rhabdomyolysis*
>need 75-100 ml/hr of urine
-C spine
>*Tetanic contractions...need C spine precautions until cleared bc the muscles could seize up so bad
it causes c spine fractures*
